What does this research mean for the field?

Bioprosthetic aortic valves are associated with lower 5-year rates of stroke and hemorrhage compared to mechanical valves, despite a higher long-term risk of reoperation in younger patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess age-stratified clinical outcomes and temporal trends in adult patients undergoing surgical aortic valve replacement with bioprosthetic versus mechanical valves.

October 1, 2020BMJ Surgery Interventions & Health TechnologiesOpen Access

Age-stratified outcomes of bioprosthetic and mechanical aortic valve replacements in an Australian cohort of 13 377 patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic valve replacement (n=13377). Intervention: Bioprosthetic valve (BV) vs. Mechanical valve (MV). Primary outcome: Reoperation, incident cardiovascular events (hospitalization or death for acute myocardial infarction, stroke, major hemorrhage or thromboembolism) and mortality (cardiovascular and all-cause).

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Key result

Bioprosthetic aortic valves linked to ~60% fewer strokes and less hemorrhage vs mechanical valves.

n=13,377

Why the study?

To quantify age-stratified outcomes of bioprosthetic valve and mechanical valve surgical aortic valve replacement in Australian patients.

Does bioprosthetic valve surgical aortic valve replacement improve clinical outcomes compared to mechanical valve replacement in age-stratified patients?

Key Points

To assess age-stratified clinical outcomes and temporal trends in adult patients undergoing surgical aortic valve replacement with bioprosthetic versus mechanical valves.
Retrospective population-based cohort study linking morbidity and mortality registry data for N=13,377 patients (26% aged 18-64 years; 74% aged 65+ years) undergoing surgical aortic valve replacement in Australia between 2001 and 2013.
Calculated age-standardized implantation rates and multivariable-adjusted incidence rate ratios (IRRs) adjusting for age, sex, and Charlson Comorbidity Index over up to 10 years of follow-up.
At 5 years, bioprosthetic valves were associated with lower rates of stroke (IRR: 0.40, 95% CI 0.27 to 0.60) and major hemorrhage (IRR: 0.36, 95% CI 0.26 to 0.50) across all patients.
In patients aged 65 years and older, bioprosthetic valves demonstrated lower rates of myocardial infarction (IRR: 0.71, 95% CI 0.53 to 0.96), hemorrhage (IRR: 0.77, 95% CI 0.62 to 0.95), cardiovascular mortality (IRR: 0.80, 95% CI 0.69 to 0.92), and all-cause mortality (IRR: 0.85, 95% CI 0.74 to 0.97).
At 6-10 years of follow-up among patients aged 18-64 years, bioprosthetic valves had substantially higher reoperation rates (IRR: 5.48, 95% CI 2.38 to 12.62) but lower rates of myocardial infarction (IRR: 0.49, 95% CI 0.26 to 0.94) compared with mechanical valves.

Study Design

Type

Cohort (n=13,377)

Multicenter

Yes

Structured PICO

Does bioprosthetic valve surgical aortic valve replacement improve clinical outcomes compared to mechanical valve replacement in age-stratified patients?

Population

13,377 Australian patients aged 18 years and over undergoing surgical aortic valve replacement (AVR) from 2001 to 2013, stratified by age (18-64 years [n=3464, 26%]; 65+ years).

Intervention

Bioprosthetic valve (BV) surgical aortic valve replacement

Comparator

Mechanical valve (MV) surgical aortic valve replacement

Outcome

Age-standardized index AVR rates; rates and multivariable-adjusted incidence rate ratios (IRRs) for reoperation, incident cardiovascular events (hospitalization or death for acute myocardial infarction, stroke, major hemorrhage or thromboembolism) and mortality (cardiovascular and all-cause)hard clinical

Bioprosthetic aortic valves are associated with lower risks of stroke and hemorrhage but a significantly higher risk of reoperation in younger patients (18-64 years) at 6-10 years follow-up compared to mechanical valves.

Discussion

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Implication

Bioprosthetic valves may lower stroke and hemorrhage risks; leaves open optimal choice versus mechanical valves in younger patients.

Cite This Study

Sotade et al. (2020) conducted a cohort in Aortic valve replacement (n=13,377). Bioprosthetic valve (BV) vs. Mechanical valve (MV) was evaluated on Reoperation, incident cardiovascular events (hospitalization or death for acute myocardial infarction, stroke, major hemorrhage or thromboembolism) and mortality (cardiovascular and all-cause). Bioprosthetic aortic valves were associated with lower 5-year rates of stroke (IRR 0.40; 95% CI 0.27-0.60) and hemorrhage (IRR 0.36; 95% CI 0.26-0.50) compared to mechanical valves.

synapsesocial.com/papers/6a13e4132ecb6dc541892428 https://doi.org/10.1136/bmjsit-2020-000036

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Age-stratified outcomes of bioprosthetic and mechanical aortic valve replacements in an Australian cohort of 13 377 patients

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Age-stratified outcomes of bioprosthetic and mechanical aortic valve replacements in an Australian cohort of 13 377 patients

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

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